Endometriosis - spectrum of findings
Type:Educational Electronic Presentation
Authors: José Eduardo Rosa, Pedro Lameira, Sónia Palma, Manuel Abecasis
Keywords:Endometriosis; Endometrioma; Adhesions; Magnetic Resonance
Educational objective

To review and discuss clinical cases regarding different types of endometriosis.

To illustrate the radiological features of endometriosis using magnetic resonance images (MRI).

Fig 1 – T1 - weighted images with fat suppression (a) and turbo spin echo (b) showing the presence of endometriosis ascites (red arrow).

Topic Review

Endometriosis is a chronic multifocal gynecologic disease affecting women of reproductive age and may cause pelvic pain and infertility.

Endometriosis is characterized by the presence of functional endometrial glands and stroma outside the uterus, which respond to hormonal stimulation, with cyclic haemorrhage that induce an inflammatory response and fibrous reaction.

Clinical manifestations depend on the anatomic locations of the disease and the primary locations of endometriosis are in the pelvis: on the ovaries, uterus, fallopian tubes, uterosacral ligaments (USL), broad ligaments, round ligaments, cul-de-sac, rectosigmoid colon, bladder, ureters, and rectovaginal septum (RVS). There are some rare locations, like the thorax, diaphragm and sciatic nerve.

The main different types of endometriotic lesions are endometrial ovarian cysts (endometriomas); small...

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Fig. 2 – MRI images: T2- weighted coronal images (a); T1- weighted after contrast (30s) coronal images (b); T2- weighted sagital turbo spin echo images (c) showing a focal bladder extrinsic thickening that enhances (red arrow), which was biopsied and was compatible with bladder endometriosis.


The definitive diagnosis is based on laparoscopy and histology, but radiology plays a major role in treatment planning. MRI is the best imaging technique because it provides a better definition and extension of deep endometriosis than transvaginal ultrasound and physical examination.

For the radiologist, the knowledge of the radiological aspect of pelvic anatomy, normal and deranged is essential. Proper diagnosis of these can allow the best surgical approach and less post-operative complication rates.

Fig. 3 – MRI images: T2-weighted sagital turbo spin echo images show a stromal/fibrotic plaque of the posterior uterus (red arrow) with adhesions extending from the torus uterinus and uterus through the rectouterine space. Bowel-invasive endometriosis of the rectum is also present.